Epidural haematoma – surgical — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

HardNeurologyEpidural haematoma – surgicalRACP Paediatrics

A 10-year-old is hit by a car and has a GCS of 8 (E2V2M4). CT head shows a large acute epidural haematoma with 8 mm midline shift. The right pupil is fixed and dilated. What is the most appropriate immediate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Neurosurgical consultation for ICP monitoring

An acute epidural haematoma with midline shift and signs of uncal herniation (ipsilateral fixed dilated pupil, contralateral hemiparesis) is a neurosurgical emergency requiring urgent craniotomy and haematoma evacuation. While awaiting surgery: head elevation 30°, maintain normotension, hyperventilate briefly if signs of herniation, and consider osmotherapy (hypertonic saline or mannitol).

Reference: RCH Melbourne – 2023 – Severe TBI CPG; RACP Paediatric Curriculum – Emergency/Neurosurgery